2020-07-15T06:54:15-05:00 2019-06-30 261659234 CW ASSOCIATES CPAS 700 BISHOP STREET SUITE 1040 HONOLULU HI 96813 990 2018-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF EXECUTIVE DIRECTOR 8087919400 2020-07-15 1 MELANIE A KING P00220997 8085311040 67.53.223.34 2020-07-15 01:42:12 HS P 8C88AA400D19617837465336ECDACC50D65DF9B9 3A0E02035B30E034326A70EEA848C8FFD1CCDEA9 2018 2021-01-29 14:40:06Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 18019504 0 X WWW.KKV.NET X 1972 HI KOKUA KALIHI VALLEY AND AFFILIATE (THE "CENTER") WERE INCORPORATED IN THE STATE OF HAWAII IN MAY 1972 TO PROMOTE HEALTH AND TO PROVIDE COMPREHENSIVE FAMILY SERVICES IN THE KALIHI VALLEY COMMUNITY IN THE CITY & COUNTY OF HONOLULU, HAWAII. THE CENTER IS A FEDERALLY-QUALIFIED HEALTH CENTER THAT PROVIDES A BROAD RANGE OF HEALTH AND SOCIAL SERVICES TO A LARGELY MEDICALLY-UNDERSERVED IMMIGRANT POPULATION. 10 10 242 90 0 0 9214416 8372631 9630560 9399949 39942 69461 162108 171929 19047026 18013970 0 0 0 0 12441378 12947190 0 0 0 5359242 5526821 17800620 18474011 1246406 -460041 19865567 19652311 1992384 2331646 17873183 17320665 TOGETHER WE WORK TOWARD HEALING, RECONCILIATION AND THE ALLEVIATION OF SUFFERING IN KALIHI VALLEY, BY SERVING COMMUNITIES, FAMILIES AND INDIVIDUALS THROUGH STRONG RELATIONSHIPS THAT HONOR CULTURE AND FOSTER HEALTH AND HARMONY. 0 0 14913523 9548035 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 14913523 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 64 0 242 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X DALLYS VEGA CHIEF FINANCIAL OFFICE 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 PUA AUYONG PRESIDENT 1.00 X X 0 0 0 SANDRA HARVEY VICE PRESIDENT 1.00 X X 0 0 0 EDWARD KEMPER SECRETARY 1.00 X X 0 0 0 THOMAS KUSATSU TREASURER 1.00 X X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 KAREN KAY FOX DIRECTOR 1.00 X 0 0 0 GEOFFREY PANG DIRECTOR 1.00 X 0 0 0 RICKEY MURASHIGE DIRECTOR 1.00 X 0 0 0 MICHAEL L WAGNER DIRECTOR 1.00 X 0 0 0 VANESSA DACUMOS DIRECTOR 1.00 X 0 0 0 RYAN LEONG DIRECTOR UNTIL OCTOBER 2018 1.00 X 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 40.00 X 190981 0 52156 DALLYS GLORIBELL VEGA CHIEF FINANCIAL OFFICER 40.00 X 94824 0 21655 JO AYERS CHIEF OPERATING OFFICER 40.00 X 80206 0 14209 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 188312 0 23365 JASON HIRAMOTO CO - DENTAL DIRECTOR 40.00 X 143588 0 20078 MYA HLA PSYCHIATRIST DIR OF BH 40.00 X 137745 0 37802 SHINJI ITO PHYSICIAN 40.00 X 128424 0 28378 OLIVIA KAPONO PHYSICIAN 40.00 X 130858 0 29180 NATHAN TAN PHYSICIAN 35.00 X 124313 0 26112 1219251 0 252935 7 0 1 0 MCKESSON CORP 80 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 PHARMACY SUPPLIES 618140 5 MINUTES PHARMACY 1824 DILLINGHAM BLVD SUITE B HONOLULU HI 96819 PHARMACY DISPENSING FEE 423114 ZR SYSTEMS GROUP LLC 1953 S BERETANIA ST HONOLULU HI 96819 INFORMATION TECH SUPPORT 286085 E-MDS PO BOX 2889 CEDAR PARK TX 78630 MEDICAL BILLING 241702 CVS PHARMACY ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 233422 9 215181 19850 5954095 2183505 47324 8372631 MEDICAID 624110 4631842 4631842 PHARMACY 624110 2369989 2369989 PRIVATE INSURANCE 624110 942313 942313 SELF-PAY 624110 812410 812410 CAPITATION FEES 624110 616715 616715 26680 26680 9399949 69461 69461 31449 0 31449 31449 31449 29377 19850 5534 23843 23843 88727 0 88727 88727 OTHER INCOME 624110 27910 27910 27910 18013970 9548035 0 93304 X 652195 219882 432313 8184902 7379405 805497 595204 534025 61179 2744815 2383331 361484 770074 665325 104749 14711 14711 45704 45704 1982997 1427510 555487 1920052 1780552 139500 209886 94373 115513 104617 94947 9670 800758 86394 714364 57436 353 57083 REPAIRS AND MAINTENANCE 120961 52233 68728 DUES AND SUBSCRIPTIONS 94929 76388 18541 MISCELLANEOUS 85475 69848 15627 TRAINING 52270 44019 8251 37025 4938 32087 18474011 14913523 3560488 0 618546 1399439 4846017 3757671 777533 873575 1405784 1934412 2369 127460 23467396 11907642 12215318 11559754 19865567 19652311 1190476 1426457 801908 905189 1992384 2331646 X 15795433 15270071 2077750 2050594 17873183 17320665 19865567 19652311 X -460041 -92477 X 0 1 X 1 1 1 X 5884053 7170276 7811340 9214416 8372631 38452716 5884053 7170276 7811340 9214416 8372631 38452716 197445 38255271 5784 6468 44497 71391 100910 229050 240687 399306 38062 27910 705965 39387731 39231395 0.97120 0.97270 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME AND FEES - 2014 AMOUNT: $ 119,653. 2015 AMOUNT: $ 266,076. 2017 AMOUNT: $ 38,062. 2018 AMOUNT: $ 27,910. MEDICAL RECORD CHARGES - CARETAKER HOUSING - 2014 AMOUNT: $ 873. 2015 AMOUNT: $ 873. INCENTIVE PAYMENTS - 2014 AMOUNT: $ 120,161. 2015 AMOUNT: $ 132,357. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12652786 6530300 6122486 1060003 74233 985770 2380383 2004738 375645 5086224 3298371 1787853 11559754 X 18408556 358847 3049 361896 18046660 -32690 -32690 18013970 18932369 451324 7034 458358 18474011 0 18474011 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE UNCERTAIN TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS IF THEY ARE MORE LIKELY THAN NOT TO FAIL UPON REGULATORY EXAMINATION. MANAGEMENT HAS EVALUATED KKV AND AFFILIATE'S TAX POSITIONS AS OF JUNE 30, 2019 AND 2018 AND FOR THE YEARS THEN ENDED BY REVIEWING THEIR INCOME TAX RETURNS AND CONFERRING WITH THEIR TAX ADVISORS, AND DETERMINED THAT KKV AND AFFILIATE HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED IN ACCORDANCE WITH SUCH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. KKV AND AFFILIATE ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS IN PROGRESS FOR ANY OPEN TAX PERIODS. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM KKV FOUNDATION (REPORTED SEPARATELY) 3,049. PART XI, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN NET ASSETS WITH DONOR RESTRICTIONS -27,156. FUNDRAISING - DIRECT EXPENSES -5,534. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM KKV FOUNDATION (REPORTED SEPARATELY) 1,500. FUNDRAISING - DIRECT EXPENSES 5,534. PART XI, LINE 2B - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $322,360 CONTRIBUTED RENT: $36,487 PART XII, LINE 2A - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SERVICES: $322,360 CONTRIBUTED RENT: $36,487 CONTRIBUTED RENT RELATED TO CAPITALIZED LEASEHOLD INTEREST: $92,477 KVIBE KALIHI RIDE 49227 19850 29377 1047 967 3520 49227 19850 29377 1047 967 3520 5534 23843 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 183462 0 7519 0 0 0 16688 0 35468 0 243137 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 180941 0 7371 0 0 0 16037 0 7328 0 211677 0 0 0 JASON HIRAMOTO CO - DENTAL DIRECTOR 137562 0 6026 0 0 0 12248 0 7830 0 163666 0 0 0 MYA HLA PSYCHIATRIST DIR OF BH 131566 0 6179 0 0 0 12676 0 25126 0 175547 0 0 0 SHINJI ITO PHYSICIAN 122603 0 5821 0 0 0 4867 0 23511 0 156802 0 0 0 OLIVIA KAPONO PHYSICIAN 125118 0 5740 0 0 0 4054 0 25126 0 160038 0 0 0 NATHAN TAN PHYSICIAN 119089 0 5224 0 0 0 11271 0 14841 0 150425 0 0 0 X 1 47324 PURCHASE PRICE 0 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990 IN CONJUNCTION WITH THE CFO BEFORE PRESENTING TO THE FINANCE COMMITTEE FOR REVIEW. THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THIS POLICY IS GIVEN TO ALL BOARD MEMBERS UPON COMMENCEMENT OF SUCH PERSON'S RELATIONSHIP WITH THE ORGANIZATION. EACH BOARD MEMBER SIGNS AND DATES THE POLICY AT THE BEGINNING OF HER/HIS TERM OF SERVICE OR EMPLOYMENT AND EACH YEAR THEREAFTER. FAILURE TO SIGN DOES NOT NULLIFY THE POLICY. THE POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE SALARY COMMITTEE AND APPROVED BY THE EXECUTIVE DIRECTOR. THE BOARD OF DIRECTORS APPROVES THE STAFF SALARY SCALE. COMPARABLE DATA IS OBTAINED FROM HAWAII PRIMARY CARE ASSOCIATION AND HAWAII ALLIANCE OF NONPROFIT ORGANIZATIONS (HANO). THIS PROCESS IS DOCUMENTED IN THE SALARY COMMITTEE MINUTES AND HR RECORDS. THIS WAS LAST UNDERTAKEN IN OCTOBER 2018. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 1,427,510. MANAGEMENT AND GENERAL EXPENSES 555,487. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,982,997. FORM 990, PART XI, LINE 9: CAPITALIZED LEASEHOLD INTEREST - NET CHANGE -92,477. KALIHI VALLEY COMMUNITY FOUNDATION 2239 NORTH SCHOOL STREET HONOLULU HI 96819 990329894 PROVIDE FINANCIAL SUPPORT TO CENTER HI 501(C)(3) LINE 7 KOKUA KALIHI VALLEY COMP FAMILY SVCS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0